典藏书目

Two handfuls of Zhu Ye (Bambusa Leaves, *Phyllostachys nigra* var. *henonis*), one jin of Shi Gao (Gypsum Fibrosum), half a sheng of Ban Xia (Pinellia Rhizome, *Pinelliae Ternatae Rhizoma*) (washed), two liang of Ren Shen (Ginseng Radix et Rhizoma, *Panacis Ginseng Radix et Rhizoma*), two liang of Gan Cao (Licorice Root and Rhizome, *Glycyrrhizae Radix et Rhizoma*) (roasted with honey), half a sheng of Jing Mi (Rice, *Oryzae Sativae Granum*), one sheng of Mai Dong (Ophiopogon Tuber, *Ophiopogonis Tuber*) (heart removed).

The above seven ingredients are decocted in ten dou of water until six dou remain. The dregs are strained off, and the Jing Mi is added. It is cooked until the rice is ripe and the soup is ready. The rice is removed, and the liquid is taken warm, one sheng per dose, three times daily.

[Formula Analysis]
This formula is derived from Bai Hu Tang (White Tiger Decoction) by removing Zhi Mu (Anemarrhenae Rhizoma, *Anemarrhenae Rhizoma*) and adding Ren Shen, Mai Dong, Ban Xia, and Zhu Ye. It transforms a formula of great coldness into one of clearing and tonifying. This is a modified version of Zhang Zhongjing's Bai Hu Tang. The Classics state: "For those whose form is deficient, warm them with Qi; for those whose essence is deficient, tonify them with flavor." Therefore, Ren Shen and Jing Mi are used to tonify the Qi and form; Zhu Ye and Shi Gao assist in clearing Stomach heat. Mai Dong is added to generate fluids, Ban Xia to direct rebellious Qi downward, and to further expel phlegm-fluids. Gan Cao tonifies the Middle Jiao and harmonizes the various herbs.

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If the patient's pulse has returned to normal but there is slight irritability in the late afternoon, it is because the disease has just resolved. If the person forces themselves to eat grains while the Spleen and Stomach Qi are still weak and unable to digest food, slight irritability will result. Reducing food intake will lead to recovery.

[Annotation]
"Pulse has resolved" means the pathological pulse has completely disappeared. The occurrence of slight irritability only in the late afternoon is due to the fact that the disease has just healed, and forcing food intake too early overwhelms the still-weak Stomach Qi, which cannot digest the food, causing slight irritability. Medication is not required; reducing food intake allows for self-healing.

[Collected Annotations]
Fang Youzhi states: "Forcing food intake" refers to compelling the patient to eat. "Reducing" implies that one should moderate and decrease consumption.

Yu Chang states: Commentators have linked the late afternoon to the time when the Yang Ming channel is at its peak, thus interpreting "reducing food" as equivalent to mild purgation. They fail to realize that this discusses post-illness recovery syndromes, not the transmission of the Six Channels into Yang Ming. "Late afternoon" refers to the meaning in the *Nei Jing*: when the sun sets, Yang Qi declines, hence the inability to digest food. One must not cite previous clauses regarding retained food and lightly use Da Huang (Rhei Radix et Rhizoma, *Rhei Radix et Rhizoma*) to severely injure the Spleen and Stomach.

Wang Hetian states: This describes a condition where forced eating after illness leads to a syndrome of deficiency with excess characteristics. After illness, rest and activity should follow nature; forcing oneself goes against one's constitution and causes discomfort, not merely regarding a single meal.

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In the disease of Yin-Yang Exchange following Shang Han (Cold Damage), the patient experiences heavy body, shortness of breath, urgency and pain in the lower abdomen, possibly extending to spasms in the genitalia, rising heat rushing to the chest, heaviness of the head making it difficult to lift, visual disturbances (seeing spots), and stiffness/spasms in the knees and shins. Shao Kun San (Burnt Underwear Powder) is the primary treatment.

[Annotation]
After Shang Han has newly healed, if men or women act imprudently and engage in sexual intercourse, resulting in fever and relapse, it is called "Relapse due to Sexual Exhaustion" (Fang Lao Fu). For men, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia, *Liuwei Dihuang Wan*) is used; for women, Si Wu Tang (Four Substance Decoction, *Siwu Tang*) is used, with modifications according to symptoms. If other forms of sexual misconduct occur, where the male disease transmits to the female and vice versa, exchanging the pathology, it is called "Yin-Yang Exchange." Symptoms include heavy body, shortness of breath, lower abdominal urgency and pain radiating to the genitals, knee and shin spasms, rising heat to the chest, head heaviness, and visual disturbances. These are caused by residual toxins transmitting through deficiency. Shao Kun San should be used.

[Collected Annotations]
Wang Kentang states: "Relapse due to Sexual Exhaustion" refers to relapse after intercourse when the disease has just healed or is not yet fully cured. If the symptoms resemble Yin-Yang Exchange, treat it as such. There are also cases of chills, fever, profuse sweating, heavy head, vertigo, abdominal cramping, sensation of joints separating, weak meridians, flaccid sinews and bones, immobility, emptiness of marrow and essence, and mental confusion, leading to death after prolonged suffering. In such cases, Dang Gui Si Ni Tang (Tangkuei and Ramie Root Decoction for Cold Extremities, *DangguisiNi Tang*) is appropriate. Add Fu Zi (Aconiti Lateralis Radix Praeparata, *Aconiti Lateralis Radix Praeparata*) for cold extremities; add Wu Zhu Yu (Evodiae Fructus, *Evodiae Fructus*) and Sheng Jiang (Zingiberis Rhizoma Recens, *Zingiberis Rhizoma Recens*) for severe cold. Note: If patients develop illness after intercourse following recovery, and there are no signs of Yin-Yang Exchange but rather exterior signs, do not treat it as Yin-Yang Exchange. Instead, treat it as contracting wind-cold after intercourse. Methods of sweating, vomiting, and purging should not be used lightly. Even if sweating or vomiting indications exist, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction, *BuZhongYiQi Tang*) plus Ma Huang (Ephedrae Herba, *Ephedrae Herba*) and Gui Zhi (Cinnamomi Ramulus, *Cinnamomi Ramulus*) for mild sweating, adding Pao Fu Zi (Prepared Aconite) for cold extremities. For vomiting, use Bu Zhong Yi Qi Tang plus Dan Dou Chi (Soja Semen Preparatum, *Sojae Seminis Preparatum*) to induce vomiting. Stop when appropriate. Always recognize this as occurring after a recent illness.

Fang Youzhi states: "Shang Han" includes Feng Zhong (Wind Strike). "Exchange" refers to trading or changing. When a major disease has just healed and Qi and Blood have not recovered, forcing sexual union causes the two Qi to interact and exchange, resulting in disease. Heavy body and shortness of breath indicate exhaustion of true Yuan Qi and fatigue. Urgency in the lower abdomen or spasms in the genitalia indicate the exchanged Qi attacking internally. Rising heat to the chest, head heaviness, and visual disturbances indicate deficient Yang generating heat and steaming upward. Knee and shin spasms indicate chaotic pulses and damaged sinews. The part of the undergarment near the genitals is where Yin and Yang Qi gather. Used by both men and women, it represents things returning to their origin.

Yu Chang states: In patients with Shang Han, heat toxins stored in Qi and Blood gradually disperse from the interior and exterior. However, heat toxins stored in the bone marrow have no way to excrete. Thus, upon recovery, if they engage in intercourse with healthy individuals, the male disease transmits to the healthy female, and the female disease to the healthy male. Hence it is named Yin-Yang Exchange, implying the meaning of transaction/exchange.